Unipolar depression or anorexia nervosa

Introduction to Clinical Disorders

Welcome! In our journey through Clinical Psychology, we have already looked at how abnormality is defined and the complexities of schizophrenia. Now, we turn our attention to another major disorder. Depending on your school's choice, you will study either Unipolar Depression or Anorexia Nervosa.

This chapter focuses on the symptoms (what the patient feels), the features (the facts and figures about the illness), and the explanations for why these disorders happen. We will also look at how they are treated using Drug Therapy and Cognitive Behavioural Therapy (CBT). Don’t worry if some of the biological terms seem scary—we’ll break them down step-by-step!

Option 1: Unipolar Depression

Unipolar depression is more than just feeling "sad." It is a persistent mood disorder that interferes with a person’s ability to function in daily life. Unlike bipolar disorder, where people swing between highs and lows, unipolar depression only involves the "low" pole.

Symptoms and Features

Symptoms are the subjective experiences of the patient. According to the DSM and ICD, these include:

• Emotional: Intense sadness, feelings of hopelessness, and anhedonia (losing interest in things you used to enjoy).
• Cognitive: Difficulty concentrating, negative thoughts about oneself, and thoughts of self-harm.
• Physical/Behavioural: Changes in sleep (insomnia or sleeping too much), changes in appetite, and a lack of energy (lethargy).

Features refer to the statistics and demographics of the disorder:

• Prevalence: Depression is very common; it is often called the "common cold" of psychiatry because of its high rates.
• Gender: Statistics show that women are more likely to be diagnosed with depression than men.

Explanations for Depression

1. Biological Explanation: Neurotransmitter Function

This theory suggests that depression is caused by a chemical imbalance in the brain. Specifically, it focuses on monoamines like serotonin, noradrenaline, and dopamine.

The Idea: Serotonin acts like a "master key" that regulates other neurotransmitters. If serotonin levels are too low, the signals that regulate mood, sleep, and appetite don't get through properly. Imagine a post office where the delivery drivers (serotonin) have gone on strike—the messages (mood signals) just don't reach their destination!

2. Non-Biological Explanation: Cognitive Theory

This approach looks at how we think. It suggests that people with depression have "faulty" thinking patterns. Beck’s Cognitive Triad is a famous example. He suggested depressed people have negative views about:

1. The Self: "I am worthless."
2. The World: "Everyone hates me."
3. The Future: "Things will never get better."

Quick Review: Depression is explained by low neurotransmitter levels (Biology) or negative thinking patterns (Cognitive).

Option 2: Anorexia Nervosa

Anorexia Nervosa is an eating disorder characterized by a struggle to maintain a healthy body weight and a distorted view of one’s own body shape.

Symptoms and Features

Symptoms:

• Behavioural: Severely restricting food intake and sometimes excessive exercising.
• Cognitive: An intense fear of gaining weight and a "distorted body image" (seeing oneself as overweight even when dangerously thin).
• Physical: Significant weight loss and, in females, the stopping of menstrual cycles (amenorrhea).

Features:

• Demographics: It most commonly begins during adolescence and more frequently affects females, though male cases are rising.
• Mortality: It has one of the highest mortality rates of any mental health disorder due to the physical toll on the heart and organs.

Explanations for Anorexia Nervosa

1. Biological Explanation: Genetic Influence or Neurotransmitters

Research suggests that anorexia may run in families, implying a genetic link. Biologically, it is also linked to serotonin and dopamine. High levels of serotonin have been linked to anxiety; some researchers believe people with anorexia restrict food because starving lowers serotonin levels, which temporarily makes them feel less anxious.

2. Non-Biological Explanation: Social Learning Theory (SLT)

SLT suggests we learn behaviour by observing role models. In modern society, the media often portrays "thinness" as a sign of success, beauty, and happiness.
The Process:
Observation: A teenager sees a thin model on social media.
Imitation: They copy the model’s eating habits to look like them.
Vicarious Reinforcement: They see the model getting "likes" and praise (rewards) for their looks, which motivates the teenager to keep going.

Did you know? The contemporary study by Becker et al. (2002) found that when television was introduced to Fiji, the rates of disordered eating among teenage girls increased significantly!

Treatments for the Disorders

Regardless of whether you study Depression or Anorexia, the curriculum requires you to know about Drug Therapy and CBT.

1. Drug Therapy

Drugs aim to fix the biological "imbalance."

• For Depression: Usually SSRIs (Selective Serotonin Reuptake Inhibitors). These work by stopping the brain from "mopping up" serotonin too quickly, leaving more available to send messages between neurons.
• For Anorexia: While there is no "anorexia pill," drugs like antidepressants (SSRIs) or antipsychotics are sometimes used to help manage the anxiety or obsessive thoughts about food.

2. Cognitive Behavioural Therapy (CBT)

CBT is a "talking therapy" that focuses on the link between thoughts, feelings, and actions. It is based on the idea that if you change your thoughts, your feelings and behaviours will follow.

• Identify: The therapist helps the patient identify "irrational" or "maladaptive" thoughts (e.g., "If I eat this, I will immediately gain 10 pounds").
• Challenge: The therapist asks for evidence. "Is it factually true that one snack changes your weight that much?"
• Homework: Patients are given tasks, such as keeping a mood diary or trying a "behavioural activation" task (like going for a 5-minute walk).

Key Summary Table

Use this to check your knowledge for the exam!

Common Mistakes to Avoid:

1. Mixing up Symptoms and Features: Remember, symptoms are what the person experiences (like sadness), while features are the facts about the group (like "more common in women").

2. Thinking CBT is just "talking": It’s not just a chat! CBT is structured, involves homework, and is focused on solving specific current problems.

3. Forgetting the "Unipolar" part: In exams, if you talk about "mood swings" to mania, you are describing Bipolar, which isn't on this part of the syllabus. Keep it focused on the "low" mood.